- What is your induction rate? Induction rates have more than doubled in the last 15 years, and without improved maternal or infant outcomes. In fact, the maternal and infant mortality rate has risen. http://forums.obgyn.net/ob-gyn-l/OBGYNL.0105/0908.html
- What is your C-Section rate? The WHO (World Health Organization) recommends no more than 5-10%, yet in America the rate is 33%.
- Do you or the hospital require continuous fetal monitoring (CFM)? (CFM has not been shown to improve birth outcomes since its inception in the 1970’s. In fact the only thing it has been responsible for is increasing C-section rates.
- During labor, how would you determine if my baby is in distress? In other words, what would be their criteria to determine if a C-section is warranted? If CFM is their primary method, then “buyer beware.” Your entire birth could likely be solely monitored via a telephone and CFM which virtually excludes the mother from the whole birth process.
- Will you attend my birth, or will I get whomever is on call? A midwife usually sees you for every visit AND attends your birth (the whole birth, not just the last 5 minutes). If you are in a large practice, you will see a different practitioner every visit. You have to realize if you go to a large practice you cannot assure that the OB you end up will be one you mesh with. You want and deserve someone who is dedicated to your birth, and not managing 3-4 other deliveries or patients simultaneously. Giving birth is easily one of, if not the biggest moments in your life. You do not want to share that moment with just anyone.
- What is the longest labor you have attended? What was the outcome?
- What is the longest labor you typically allow before suggesting alternative intervention, such as a C-section? My first labor was 36 hours, and yes, I had CFM and still managed to have a natural birth. My midwife and the nursing staff were big supporters – and all kept encouraging me that I could do it. And I did! By contrast, I have many stories of labors which only went on for 12 hours, resulting with a harried recommendation for a C-section because the labor was not progressing.
- Will you allow me to position myself for the actual birth? Some hospitals and many health care providers will “require” you to be in a lithotomy position (flat on back, feet in stirrups). This position is well known to be the biomechanically worst position for birthing, as it closes down the pelvic outlet (decreases the opening size) and creates a position where the mother must push uphill. Yes, you read it correct. Please make sure you have the freedom to move around during birth as you find most comfortable. Ask any childbirth educator or midwife – they will tell you that birth positioning is highly personal for each woman – depending on what is most comfortable. Squatting, all fours position, side lying – all of those and more are options for birthing – far better than the antiquated one that is still being forced on women today. If your health care provider answers that you must be in the lithotomy position – run away fast!
- What is your episiotomy rate? (this number better be low, or your eyebrows should raise rather high) A caregiver who believes in episiotomies and uses them casually means that you will likely be cut during birth. I have had many patients with longstanding chronic pain, including sexual dysfunction and fecal and urinary incontinence, because they either consented to an episiotomy or their doctor cut them without their permission. Furthermore, ACOG officially changed its stance on episiotomies in 2006.
- What is your unmedicated or uncomplicated birth rate? Meaning, how many natural or minimally invasive births do you attend each year? Over 80% of women receive medical intervention, and it is well founded that as medical intervention goes up, good birth outcomes go down. Research in many countries, including the US, supports that midwives have the lowest epidural rates, and with very good outcomes. C-section rates with midwifes are less than 1-2%, whereas the national average is a whopping 33% now.
- Bonus Question: Do you break the “bag of waters” very often? If so, why? Breaking the bag of waters is usually unnecessary as it will break on its own. And breaking them prematurely can make labor harder and much more painful.
*Be Cautioned! A health care provider who cannot (or flat out refuses) to answer your questions is a huge red flag that you will likely not be in charge (or fully informed of options) during your birth. A health care provider should always welcome your questions, and should never scoff at them.
*Be Glad! If you can get through this list of questions with your health care provider, and you like all the answers, you are on your way to a happy (and empowered) birth! Congratulations & for taking control of your birth!
Coming next: 5 Questions to ask the hospital that may deliver your baby.
*Cooking gingerbread men (and women!) on Thanksgiving Day 2005, pregnant with my first son.